Families living in poverty are struggling to benefit from vital early childhood services at every level, according to a joint new report from the NSPCC and UNICEF UK.
The study, Opening doors: access to early childhood services for families impacted by poverty in the UK, found that families on low incomes were missing out on maternity, health visiting and family hubs, with services often limited, hard to reach, under-resourced or unable to support those experiencing financial hardship (Nevin and Jacques, 2024).
The study drew on an analysis of existing evidence as well as new research compiled with the help of 30 parents and carers, 12 early childhood service professionals and an online survey of almost 3 000 UK families.
It is known that poverty can have a negative impact on young children's development, increasing their likelihood of ill health and poor mental health, putting them at a disadvantage before they start school.
The research found that early childhood service professionals worked under a lot of pressure, often in unsupportive environments due to shortages of midwives and health visitors. This resulted in a lack of outreach to families who needed it most, rushed appointments with struggling parents and no continuity of care. Many families were left dealing with a different professional at each point of contact, which was damaging to relationships with parents and left them unable to discuss sensitive issues around their financial circumstances.
One mother told the researchers: ‘It's really difficult when they change your midwives all the time and change your health visitor, and they change where you're going for appointments.’
‘Many families were left dealing with a different professional at each point of contact, which was damaging to relationships with parents and left them unable to discuss sensitive issues around their financial circumstances.’
Other practical barriers for parents included not being able to attend services due to transport costs, navigating complicated services, or not being able to follow advice due to a lack of money or resources.
Parents also feared the stigma attached to discussing their financial struggles with professionals and were worried about being judged.
One mother said: ‘I still find that there's judgment and that stigma to say, “How can you bring up a child if you can't manage your finances?” And things like that, I just feel like there's that stigma attached to it.’
Another said: ‘It's so overwhelming and I haven't got much food, I haven't got enough for the kids, but then if someone supports you and points you in the right direction … it's like a godsend if they tell you that's available and you're full of anxiety because you're on your last £5 and you've got children and when they're telling you towards the right directions that's amazing, they're doing the right thing.’
The charities said the anticipated UK-wide Child Poverty Strategy (Cabinet Office, 2024) and the 10-Year Health Plan in England (NHS England, 2024) offered crucial opportunities for the government to improve access to local early childhood services and ensure they are inclusive of families on low incomes.
The report also recommended more investment in rebuilding midwifery and health visiting workforces, as well as rolling out integrated services like family hubs across the country. This would require additional investment to address the shortfalls of 2 500 full-time midwives and 5 000 full-time health visitors in England by 2030.
The proposals were welcomed by Alison Morton, CEO of the Institute of Health Visiting. She said: ‘This timely research presents important findings on early childhood services, with insights from families on what they need to thrive. Sadly, it also highlights the human costs of years of underinvestment and service cuts. Far from saving money, these cuts have been a false economy. There is a clear imperative to do better.
‘Health visitor cuts create knock-on consequences across the health, education and care system; for example, increasing A&E attendance in children 0–4 years, inadequate postnatal health care, late identification of complex conditions/SEND/vulnerable children, fewer children ‘ready for school’, falling immunisation rates, and a mental health crisis – these are all core priorities in the health visiting service that should be delivered in all areas.
‘The report is clear that high-quality health visiting services, and the parent-professional relationship, are fundamental to whether babies and young children can access the support they need during these critical earliest years of life.’
She added that this must involve reducing the caseloads of health visitors, many of whom have 500, 750 or even 1000 families to help and support.
‘Turning this around requires a clear plan with funding to reverse the loss of more than 40% of health visitors in England since 2015’, she said. ‘Following years of cuts, rebuilding health visiting services will take time. We support the report authors' call for an increase in specialist health visitor posts to ensure that these families have access to high-quality, personalised support to meet their needs.’
Vicky Nevin, policy manager at the NSPCC and co-author of the report, said: ‘Midwives, health visitors and other professionals provide support that can make a real difference for parents who want to do the best for their young children but are struggling with money.
‘Worryingly, our research shows that service doors are often closed, hard to reach, or out of touch with the needs of families impacted by poverty. This poses serious risks to the health, wellbeing and safety of little ones.’
‘Health visitor cuts create knock-on consequences across the health, education and care system; for example, increasing A&E attendance in children 0–4 years, inadequate postnatal health care, late identification of complex conditions/SEND/vulnerable children, fewer children “ready for school”, falling immunisation rates, and a mental health crisis …’
Rebecca Jacques, UNICEF UK senior policy advisor, and report co-author said: ‘Early childhood services like midwifery, health visiting, and children's centres, provide a lifeline for parents and young children. These vital services can help children have the very best start by identifying any risks early on and promoting healthy development.
‘Our research shows that without high-quality support, we risk too many babies and young children falling behind.
‘It is crucial that the UK Government's upcoming child poverty and health strategies prioritise early childhood services, so that they can fulfil their role in mitigating the impacts of poverty to make sure every young child has the best chance of a happy and healthy life.’